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Edmonton pediatrician warns of service cuts thanks to changes billing

Author of the article:

Ashley Joannou

Publishing date:

April 29, 2020 • 3 minute read

David Shepherd, NDP Opposition critic for health, and Rakhi Pancholi, MLA for Edmonton-Whitemud, were joined on April 28, 2020, by families of medically fragile children to call on Health Minister Tyler Shandro to reverse his policies that will limit their access to specialized primary care.Dave DeGagne/ dbphotographics.ca

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An Edmonton pediatrician for children with complex medical needs says more of her patients will likely end up in an emergency room because of changes the Alberta government made to how doctors are paid.

Dr. Rehana Chatur, one of the pediatricians at Garneau Pediatric Associates, says the new limit on how many services a doctor is paid for each day means she’ll eventually have to lay off staff. Fewer staff means fewer patients can be seen and some will have to be turned away to go to the emergency room, she said Tuesday.

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Chatur is the latest Alberta physician to raise concerns about the government’s decision to impose changes to how doctors can bill for services starting April 1.

Steve Buick, press secretary for Health Minister Tyler Shandro called Chatur’s claims, made at an NDP press conference, “misleading.” According to Buick the government has looked at the clinic’s billing and the new model for billing won’t materially change its revenue.

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One of the government’s changes says doctors are only allowed to charge for 65 “patients” a day. The first 50 fees are covered in full and the last 15 at 50 per cent. Chatur said the count is more than just people who walk through the door and includes services like calls from pharmacists or a consultation with another doctor over the phone.

“All of these are called ‘patient encounters’ so that cap of 50 does not just include patents that physically come into the office. It includes all patient encounters in that particular day,” she said.

On its website, the Alberta government says on average, a general physician sees 22 patients per day and a specialist sees 13. The government says too many patients may compromise patient safety care, as well as contribute to physician burnout.

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On an average day, Chatur estimates her practice — with two doctors working — has approximately 120 patient encounters. During cold and flu season that number can climb to approximately 140.

In a statement, Buick said “billing data shows this clinic rarely sees more than 50 patients per physician per day. The cap should not reduce its revenues materially.”

Buick added Alberta Health staff “will reach out to the clinic to clarify how the cap should apply.”

The clinic offers services that would normally be done in a hospital, like IV starts and blood draws, as well as a 24/7 on-call doctors. Parents are able to bring their kids in immediately if there is a concern, Chatur said.

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Part of how they are able to see that many patients is by employing 11 nurses and 10 administrative staff. Those staff do a full medical history, answer questions and take vital signs. Doctors do an exam and come up with a treatment plan.

If the government’s cap stays in place, Chatur said the clinic would eventually have to lay off nurses and administrative staff, meaning doctors will see fewer patients. The clinic would not be able to see patients right away “and we would then have to send them to the emergency department to receive their care,” she said.

Lindsey Kemp and her son George started visiting the clinic in 2016, when he was in heart failure. He’s had two heart transplants since then.

Kemp said she was at the clinic weekly or more after George’s transplants. “Anxiety is high. I can’t even imagine what it would be like to not be seen that day. Even just a phone call.”

NDP health critic David Shepherd reiterated that the opposition wants the government to temporarily restore the old contract with doctors that it tore up prior to the changes, and enter into arbitration with a third party.

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